HighlightsUK-VARSS 2017Published October 2018

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Antibiotic Sales Overall trends in mg/kg

Sales of highest priority critically important antibiotics (HP-CIAs) in food-producing animals dropped by a further 0.86 tonnes (29%) from an already low level in 2016; an overall drop of 2.35 tonnes (52%) between 2013and 2017.

Overall, tetracyclines remain the most sold antibiotic class (37%), followed by beta-lactams (28%) and trimethoprim/sulphonamides (11%). Sales of HP-CIAs in all animal species represent a small proportion (0.8%) of the overall antibiotic sales.

Total sales in tonnes of active ingredient by antibiotic class (all animal species)

= 1 tonneFQ = fluoroquinolones* Includes 3rd and 4th generation cephalosporins.** Includes amphenicols, lincomycins, pleuromutilins, steroidal antibiotics and polymyxins (including colistin).

Trimethoprim/Sulphonamides

Beta- lactams*

3rd/4th

generation cephalosporins

FQTetracyclines Macrolides Colistin

1.3 0.9 7 (kg)

10578

31 23

11 0.6 0.26Difference in tonnes from 2016

Amino-glycosides

24Highest Priority

Critically Important Antibiotics

Other**

19

0.13 37 2 1

Tonn

es s

old

in 2

017

In 2017, sales of veterinary antibiotics for use in food-producing animals, adjusted for animal population, were 37 mg/kg; an 8 mg/kg (18%) drop from 2016, and 25 mg/kg (40%) decrease from 2013.

Sale

s in

mg/

kg 57

45 37

010203040506070

45

6262

2013 2014 2015 2016 2017

Total sales (all animals, tonnes)

Sales (all antibiotics, mg/kg)

Fluoroquinolones (mg/kg)

Colistin (mg/kg)

3rd/4th generation cephalosporins (mg/kg)

338408448436

45576262

0.230.340.350.36

0.150.170.190.18

0.020.120.120.11

201520142013 2016 2017

282

37

0.16

0.12

0.001

21%

17%

30%

Comparedwith 2016

18%

94%

32%

35%

55%

Comparedwith 2013

40%

99%

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Antibiotic usage by food-producing animal species

Antibiotic usage refers to the amount of antibiotics purchased, prescribed and/or administered per sector. The data have been collected and provided to the VMD by the animal industry on a voluntary basis:

* Represents the % animals covered by the data, except gamebirds which represents an estimate of the % total antibiotic sales. ** mg/kg relates to the amount of active ingredient normalised by kg biomass and calculated using ESVAC methodology, % doses refers to the‘actual daily bird-doses/100 bird-days at risk’, tonnes and kg relates to the amount of antibiotic active ingredient. More details are provided in the methods sections.† Due to the small sample size, and the fact that these data are from a convenience sample, results may not be represenative of the situation across the UK. In addition, because of the differences in the sample population of farms between years, caution should be taken when interpretingtrends.

The usage data from the meat poultry and pig sectors highlight how the reductions achieved in 2017 have built on the reductions reported in previous years:

Gamebirds

Trout

Dairy

Beef

2.290 0Laying hens

Salmon

0.57 % doses

13 90* 49.6 kg 22

0.270 0

xx28

3.0 100 0

19 mg/kg

17 mg/kg

0.95† 0.3 mg/kg

4.231† 0.6 mg/kg

19 mg/kg

17 mg/kg

Total coverage %*

2017 Total tonnage

1490

87

2017 Total per unit**

45 mg/kg

131 mg/kg

HP-CIA usage

Comparedwith 2016 %

0.03 mg/kg

0.1 mg/kg

Comparedwith 2016 %

28

Broilers

Ducks

Pigs

Turkeys

10 mg/kg

3 mg/kg 0

63

48

7542

22

36

35† 28†

Antibiotic Usage

131183

2014 (mg/kg)

Broilers

Ducks

Pigs

Turkeys

2015 (mg/kg)

2016 (mg/kg)

2017 (mg/kg)

278

220 200

49 27

15 8

86

17 10

3 3

45

Compared with 2015 (pigs) or 2014 (meat poultry)

53%

79%

80%

78%

90

100

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Antibiotic Resistance in Zoonotic and Commensal Bacteria from Healthy Animalsat Slaughter

Resistance in Escherichia coli from pigs

Similar to 2015, resistance to ciprofloxacin (fluoroquinolone) in indicator E. coli from healthy pigs at slaughter was low in 2017 (1.6%, up from 0.7% in 2015); and no resistance was detected to the other HP-CIAs. Resistance to nalidixic acid was up from 1.3% in 2015 to 2.2% in 2017.

Resistance levels to the other eight antibiotics tested were lower compared to 2015.

ESBL-, AmpC- or carbapenemase-producing Escherichia coli from pigs

In 2017, 22% (75/347) of caecal samples from the UK yielded presumptive ESBL-/AmpC-producing E. coli following selective culture, which was down from 25% in 2015. Of the 347 samples, 15% were ESBL-positive, 5% were AmpC-positive and 1% were positive for both. No presumptive carbapenemase-producing E. coli were detected.

Resistance in Salmonella from pigs

No resistance to HP-CIAs was detected in Salmonella isolates from pigs.

Testing carried out on E. coli collected as part of the EU Harmonised Monitoring Scheme

* To note this testing does not identify the type or number of ESBLs present.

150 random isolates 327 caecal samples grown on selective medium*

Resistant to3rd generation

cephalosporins

Resistant tofluoroquinolones

Positive forcarbapenemase-producing E. coli

Positive forESBL / AmpC-producing

E. coli

0% 21.6%0% 1.6%

0% 24.7%0% 0.7%

186 random isolates 347 caecal samples grown on selective medium*

2015

2017SALE

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Resistance in Salmonella spp.

A high percentage of all Salmonella isolates tested (72% of 3,111 isolates obtained in total) was susceptible to all 16 antibiotics tested. The results indicate an increasing trend in the proportion of isolates that are susceptible to all antibiotics tested.

No resistance to cefotaxime or ceftazidime (3rd generation cephalosporins) was detected in 1,707 Salmonella isolates from pigs, turkeys, chickens, cattle and sheep tested in 2017. Five isolates obtained from these animalspecies (0.3%) showed resistance to ciprofloxacin (fluoroquinolone).

Antibiotic Resistance - Clinical Surveillance

Resistance in Escherichia coli

Resistance to fluoroquinolones and 3rd generation cephalosporins was low (<4%), except in cattle (11% of isolatesresistant to fluoroquinolones, 8% resistant to ceftazidime and 14% resistant to cefotaxime; the vast majority of these isolates were obtained from calves) and turkeys (17% of isolates resistant to fluoroquinolones). No resistance to colistin was detected in any species.

n = number of samples tested

201720162015n=57

Percentage resistant to one or more other antibiotics

n=158

1009080706050403020100

n=160n=172

n=180n=111n=251

n=873n=696n=768

n=392n=336n=346

n=104n=91

3rd/4th generation cephalosporins

fluoroquinolones

0% 0%

0% 0.6%

0% 0.5%

0% 0%

0% 0%

Resistance in 2017 to:

I I I I I I I I I

% resistant isolates from poultry and pigs

fluoroquinolones

20

n=148 n=264 n=287

n=148 n=264 n=287

100I I I I I I I I I I I I I I I I I I

3rd/4th generationcephalosporins

2017 2016 2015

10

n=215 n=300 n=182

n=215 n=300 n=182

0

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BackgroundHow are sales data collected?In the UK, from 2005 it has been a statutory requirement for pharmaceutical companies to report to the VMD the amount of antibiotic products sold for use in animals. From the amounts and the product characteristics, the quantity of active ingredient is calculated which is reported here. These sales data do not take into account wastage, imports or exports of veterinary antibiotics. However, they do serve as the best currently available approximation of the quantity of antibiotics administered to animals in the UK. Usage data, i.e. the amount of antibiotics purchased, prescribed and/or administered, have the potential to provide much more precise estimates of use. The VMD has been working with the animal production sectors to develop sector-led data collection systems to monitor their antibiotic usage. Usage data are now being reported.

How are usage data collected?Data have been voluntarily provided by producers (pig, poultry and egg sectors), feed companies (gamebirds) and veterinary practices (gamebirds, cattle and fish). Usage data collection systems have been put in place to collect data from the British Poultry Council (meat poultry), the British Egg Industry Council (laying hen sector), the Game Farmers Association (gamebirds), the electronic Medicines Book (pigs), FarmVet Systems (cattle), British Trout Association (trout) and Scottish Salmon Producers’ Association (salmon).

What is the Population Correction Unit (PCU)?Trends in sales of antibiotics between years and different countries cannot be determined without taking into consideration variations in the number and size of animals that may require treatment. Therefore, sales data are analysed using the population correction unit (PCU). This is a standard technical unit of measurement developed by the European Medicines Agency and adopted by EU countries. This allows data to be presented as mg of antibiotic per kg of livestock biomass. For more details see:

https://www.gov.uk/government/publications/understanding-the-mgpcu-calculation-used-for-antibiotic-monitoring-in-food-producing-animals

What are Critically Important Antibiotics (CIAs)?Certain antibiotic classes are categorised by the World Health Organization (WHO) as critically importantantibiotics for human use, of which several are designated as ‘highest priority critically important antibiotics’(HP-CIA). In December 2014, the European Medicines Agency published scientific advice on the risk to humans from antibiotic resistance caused by the use of HP-CIAs in animals. This advice classed macrolides as category 1, where the risk of use in animals to public health is low or limited, whereas fluoroquinolones and 3rd and 4th generation cephalosporins were classified as category 2, where the risk to public health is considered higher. Following discovery of a novel gene conferring resistance to colistin and capable of horizontal transmission (mcr-1) in November 2015, this advice was updated, and it was recommended that colistin was moved to category 2, alongside fluoroquinolones and 3rd and 4th generation cephalosporins.

How is antibiotic resistance interpreted?Antibiotic resistance in bacteria isolated from animals is monitored through two distinct antibiotic resistancesurveillance programmes: the compulsory EU Harmonised Monitoring Scheme (from healthy animals) and the voluntary Clinical Surveillance programme (from sick animals).

For the EU Harmonised Monitoring scheme, both EUCAST human clinical break points (CBPs) and EUCAST epidemiological cut-off values (ECOFFs) were used to determine the susceptibility of the different bacterial populations. Susceptibility results included in the highlights section as well as in the main body of the report were interpreted using CBPs. Results interpreted using both human CBPs and ECOFFs are provided in full in Table S3.1.1, S3.2.1 and S3.3.1 of the supplementary material.

For the clinical surveillance programme, resistance in bacteria was interpreted using BSAC human CBPs. Where BSAC CBPs were not available, a historical APHA veterinary breakpoint (13 mm zone size diameter) has been used to indicate resistance (see Table S4.1.1 of the supplementary material for further details).

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